Dr. Goodin is Associate Professor, Capital University, School of Nursing, and Dr. Stein is Associate Professor, The Ohio State University, College of Education and Human Ecology, Columbus, Ohio.
This manuscript was presented in part at Creating the Future through Renewal, the 38th Biennial Convention of Sigma Theta Tau International, Indianapolis, Indiana, November 15, 2005.
Address correspondence to Heather Janiszewski Goodin, PhD, RN, Associate Professor, Capital University, School of Nursing, 1 College and Main, Columbus, OH 43209; e-mail: email@example.com.
Leading a productive discussion is one of the most challenging and satisfying endeavors an educator can embrace (Cross, 2002). Nurse educators are not strangers to the discussion method as a teaching strategy and the complexities of its use in the classroom. What is appealing about deliberative discussion is that this particular kind of discussion teaching method follows a process that is straightforward and stimulating. A deliberative discussion is purposeful in its approach and provides educators with the opportunity to engage learners in a meaningful dialogue. Therefore, the purpose of this article is to describe the deliberative discussion method as a teaching strategy and offer suggestions for nurse educators to incorporate deliberative discussions into their own teaching practice.
What Is a Deliberative Discussion?
Virtually unknown in nursing education, the deliberative discussion method has existed for over 25 years in public forums and community groups. The idea of conducting deliberative discussions was first developed by the National Issues Forums (NIF). Initiated in 1981, the NIF is a nonpartisan, nationwide network representing educational and community organizations that bring people together to talk about important public issues (NIF Institute, n.d.). In essence, “NIF’s simple goals of developing sound public judgments through increasing citizens’ cognitive and deliberative skills are well-suited to the deliberative approach” (Gastil & Dillard, 1999, p. 189). What sets this kind of discussion apart from other discussion methods is the process of deliberation.
According to Brookfield and Preskill (2005):
Deliberation refers to the willingness of participants to discuss issues as fully as possible by offering arguments and counterarguments that are supported by evidence, data, and logic and by holding strongly to these unless there are good reasons not to do so. (p. 13)
Bridges (1994) characterized deliberation as a collaborative group discussion that is analytical, reasonably reflective, and painstaking. It is a purposeful and serious discourse that does not rush toward a decision but rather toward careful consideration of alternative points of views and choices (Bridges, 1994). The essence of deliberation is two-fold:
- To weigh alternatives and discuss all possible courses of action related to a public problem (Parker, 2001).
- To focus on “What should we do?” toward resolving the question of the right action, rather than solving the problem (Dillon, 1994).
Deliberative discussions differ from debates in that a debate keeps participants in deeply entrenched positions, whereas deliberation asks participants to listen to each other to develop a deeper understanding of alternative viewpoints (Heanue, Kranich, & Willingham, 2003). Primarily, deliberative discussions are a form of shared inquiry that engages the participants throughout the deliberation in hopes that the discussions will continue outside the forum toward civic action. Encompassed within a shared spirit to learn and understand, participants need to listen to each other and the issues at hand. In addition, the process is structured such that any community or educational institution can use its format to conduct its own deliberative discussions.
The Deliberative Discussion Method
Deliberative discussions were originally intended to take place among citizens in an open forum. The moderator of the deliberative discussion is an individual familiar with the method or educated by the NIF to conduct the public forum and guide the participants through the dialogue.
The moderator begins the forum by establishing ground rules. This is a common mechanism for setting the charge of the participants and clarifying the purpose of the discussion. The moderator then introduces the work of deliberation and the focus of the deliberative discussion. Because participants rarely read preparatory materials prior to the discussion, it is important that the moderator offer a brief summary of the issue either by reading or by showing a short 10-minute to 15-minute videotape. After the brief introduction, the moderator connects the issue to the participants’ lives by inviting them to take a personal stake. Participants are given the opportunity to share their personal experiences with the issue, which helps to make the issue real and pertinent.
The majority of the forum consists of the work of deliberation. Three or four approaches indicate the basic ideas of the public issue, thus ensuring that at least one point of view will be respectfully represented for each participant. According to Burkhalter, Gastil, and Kelshaw (2002), “A discussion is more deliberative if it takes into account a broad range of perspectives on a issue” (p. 402). Burkhalter et al. (2002) also stated that group members are likely to participate in deliberation if they are motivated to hear and process the contents of the arguments. Meanwhile, the moderator remains neutral while guiding the participants through the deliberative process and having them weigh all of the alternatives of the issue.
Moderators play a significant role in deliberation. According to Gastil and Dillard (1999):
Moderators encourage participants to connect choices with values, illustrate their ideas with personal stories or examples, consider hypothetical dilemmas, and explore the consequences of actions for different people. (p. 185)
The moderator needs to possess excellent facilitation skills for successful dialogue and learning to occur. Participants are encouraged to think not only as individuals but also as members of a larger community (NIF Institute, n.d.). Finally, the moderator’s behavior, in terms of modeling active listening and the democratic process, could influence the behavior of other group members (Gastil, 2004). Therefore, the moderator must be skilled in the deliberative discussion format for an effective discussion to evolve.
According to the NIF Institute (2001), the four main questions that the moderator asks the participants include:
- What is valuable to us in this issue?
- What are the costs and consequences associated with the various options?
- Where are the conflicts in this issue that we have to work through?
- Can we detect any shared sense of direction or common ground for action?
The goal of the discussion is not to conclude with one final solution, but rather to identify commonalities within the issue and collectively decide what action the group could take. Because the participants of deliberative discussions consider all the costs and consequences of an issue, multiple solutions are possible. Therefore, it is the moderator’s role to move the group from talking and critically thinking about solutions to taking action in their community. The action piece of the deliberative discussion is determined by the group and engages participants to assume civic responsibility.
The end of the forum is reserved for reflection and discovering a shared sense of purpose and accomplishment. Some questions suggested by the NIF Institute (2001) to guide this portion of the deliberation include:
- How has your thinking about the issue changed?
- What didn’t we work through?
- How can we use what we learned in this forum?
- What, if anything, do we want to do next?
Providing participants with the opportunity to reflect allows them to realize how their interests are interconnected and how their perceptions can create new possibilities for acting together. It is thought that engaging in deliberative discussions could potentially broaden political conversations, but it may not promote the full range of democratic effects as some proponents would believe (Gastil, 2004).
The intent of a deliberative discussion is to have participants engage in a face-to-face discussion that moves through a structured process. It is this process that is believed to facilitate higher levels of thinking and help participants find common ground for action. Although the desired outcome of the forum would be a call for civic action, the deliberative discussion format has many possibilities to stimulate thinking and learning among participants.
Implications for Nursing Education
The deliberative discussion structure allows the educator (moderator) to move the learners (participants) through a guided process that, by its very nature, is productive and meaningful. Deliberative discussions have a purpose—they invite learners to engage in a dialogue that may evolve into a mutual understanding and set the stage for future action. On one level, it is important for nursing students to talk about issues that affect health care and their roles within the health care system. Topics such as Death and Dying, or Alcohol: Controlling the Toxic Spill have already been developed by the NIF and can be incorporated into any introductory nursing course. Educators can use the moderator guide offered by the NIF to introduce the different choices to the issue and use the discussion questions as a platform for students to begin talking about the choices and gain greater clarity on public health issues. For example, the first choice of action could be Demand Citizen Responsibility, as in the alcohol issue. Students can be asked what is appealing about this choice, as well as what opponents might say and what the consequences of this choice might be. Students can discuss each of the choices and then collectively deliberate on all of the choices.
Deliberative discussion may help foster critical thinking, as it requires students to think deeply, consider all viewpoints of the issue, and contemplate the complexities of possible solutions. Students would have to begin examining their own belief systems and the assumptions they could be making about the public issue. The discussion could also foster a sense of community among the participants because all contributions to the discussion would be heard and valued.
On a higher level, deliberative discussions could facilitate dialogue among nursing students (undergraduate or graduate) to move beyond the discussion phase to an action phase by doing something about the problem. For example, nursing students could talk ad nauseam about the problems of underage or binge drinking on college campuses. However, a deliberative discussion could move students to deliberate on what they could do as a group to act on the problem. Students who engage in civic action are those who would perhaps, as a result of participating in the class topic Alcohol: Controlling the Toxic Spill, decide to engage in civic responsibility to combat the problem. This is the more challenging aspect of deliberative discussions—moving the students from the talking phase to becoming active participants in their communities. However, students could also take action by motivating themselves to learn more about the issue (e.g., What programs are in place at my learning institution to curb or eliminate underage drinking?) or simply by talking to other people (e.g., What do we think about underage drinking on our college campuses?).
Moderator guidelines and deliberative discussion forum topics can be accessed free of charge on the NIF Web site ( http://www.nifi.org). There are many health and well-being issues that are applicable to nursing education; however, the NIF has also developed other categories of engaging discussion issues such as children and family, civil rights, education, environment, and politics. A brief overview of each of the approaches to the issue could be given to the learners prior to class, or the class could watch a video that would introduce the topic. However, the deliberative discussion process could be adapted and applied to any health care issue. For example, the nursing shortage is a hot topic, and many decisions are being made, both statewide and nationwide, to better inform and involve nurses. In this instance, students could research the approaches currently being used or considered to address the nursing shortage and deliberate as to what solutions might work best.
The deliberative discussion works best if learners are first oriented to the deliberation process and are provided with opportunities to reflect on the process afterward. When learners reflect on what worked or did not work during the deliberative discussion, they can approach future discussions with new insight as to how the learning experience might unfold.
Because it is difficult for the educator to moderate the discussion and simultaneously record the learners’ contributions, a second recorder would be beneficial. Learners could be selected from the class to record their colleagues’ responses on a dry erase board or flipchart. Documenting what is said during the deliberative discussion helps to validate the learners’ contributions and allows the participants to review what was discussed. The educator can revisit what was recorded for clarification and provide opportunities for summarization, reflection, and possible action.
The use of deliberative discussions in nursing education has the potential to enhance learning and critical thinking at every level of the curriculum. The deliberative process involved in this kind of discussion teaching method encourages learners to examine multiple viewpoints of an issue and gain a deeper understanding of health care problems in our society. It is also important for nurses and nursing students to be familiar with and be able to speak about the public issues affecting their health and the health of the nation. Finally, it provides nurse educators with a unique and structured approach to using discussion in the classroom and possibly offers a platform for learners and nurses to better their communities through civic action.
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